Pharmacist

Blue Cross Blue Shield of Massachusetts•Hingham, MA

14d•$118,000 - $147,290

About The Position

The Clinical Pharmacist Reviewer reviews formulary exception, prior authorization, and quantity limit exception requests received from providers by phone and fax. The role supports Retail Pharmacy, Medicare Advantage Part D, Home Infusion Therapy, and Medical Utilization Management benefits. The schedule is Saturday from 8 a.m. to 4 p.m. and four weekdays.

Requirements

Professional Registered Pharmacist degree.
Unrestricted, current, and valid license to practice pharmacy in Massachusetts and/or another relevant or applicable state.
Experience in a managed care setting, on the provider, payer, or PBM side of the industry.
Proficiency with standard computational office-suite applications, including word processing and relational database manipulation.
Excellent written and oral communication skills.
Excellent interpersonal skills.
Strong organizational and time-management skills, including the ability to work independently and prioritize multiple projects and assignments.
Demonstrated strength in analysis, identifying problems, and resolving issues.
Excellent teamwork skills and ability to use team approaches to set and attain goals.
Results-oriented.
High school degree or equivalent, unless otherwise noted above.

Nice To Haves

Graduate study in business, public health, or health policy.
Experience directly supervising technical support staff for clinical, service, and/or operational programs.

Responsibilities

Participate in the implementation and management of Prior Authorization, Formulary Exception, Step Therapy, and Quality Care Dosing programs.
Support Pharmacy Operations analysts with day-to-day approvals and denials while maintaining compliance with regulatory requirements.
Support the product portfolio, including Medicare Part D, with rotational weekend and holiday support for timely determinations.
Support Home Infusion Therapy, Specialty Pharmacy Network, and Medical Utilization Management pharmaceutical programs.
Partner with clinical and non-clinical teams on staff training, meeting facilitation, and ad hoc presentations.
Participate in developing and designing drug utilization programs and new clinical program opportunities.
Facilitate assigned special projects.
Develop drug information, training, and support for internal and external customers.
Analyze and resolve issues raised by MAPS, Health and Medical Management, IT & Ops, the PBM account support team, and other customer service areas.
Develop communication strategies for program initiatives in partnership with Clinical Pharmacy for internal and external customers.
Identify opportunities for workflow efficiencies and new clinical quality and cost-saving programs.